Martin Pook

Evaluation of manual-based cognitive-behavioral therapy for bulimia nervosa in a service setting.

In the present study manual-based cognitive-behavioral therapy for bulimia nervosa was evaluated on an unselected sample of an out-patient service facility. A total of 73 female patients who asked for treatment received the primary diagnosis of bulimia nervosa. Of these, 67 took up treatment. Treatment was completed by 66 patients. Outcome variables were the number of binge episodes along with questionnaire scores for restraint eating, emotional eating, body dissatisfaction and depressiveness. At the end of treatment and 1 year after the end of treatment significant improvements were found in all outcome variables. Effect sizes for outcome variables were within the range of those of controlled research. Therefore, the present study delivered empirical evidence that manual-based cognitive-behavioral therapy is an effective treatment for bulimia nervosa not only within the restricted area of research.

Cognitive-Behavioral Therapy for Idiopathic Infertile Couples

Background: The purpose of this pilot study was to evaluate the impact of a 6-month cognitive-behavioral therapy for infertile couples. Methods: Seventeen idiopathic infertile couples participated in a therapy program comprised of modules to behaviorally optimize the chance of conception, improve sexual functioning and satisfaction, reduce thoughts of helplessness and, if necessary, improve marital communication skills. Pre- to posttreatment changes in the therapy group were compared to changes in two control groups. Results: The therapy group showed an improvement in sperm concentration, a reduction in thoughts of helplessness and a decrease in marital distress. By the end of therapy participants practiced timed intercourse more reliably and reported unchanged sexual pleasure and satisfaction during the nonfertile period of the menstrual cycle. At the 6-month follow-up, problem-focused thoughts had decreased. The live birth rate was higher in the therapy group than in epidemiological samples. Conclusion: Preliminary data suggest that cognitive-behavioral treatment may be an effective approach for the treatment of infertility.

Evaluation and comparison of different versions of the Body Shape Questionnaire

The Body Shape Questionnaire (BSQ) is a widely used scale to assess body dissatisfaction. Several short forms of the BSQ have been introduced. In the present study, the full-length 34-item version of the BSQ and seven derivations were evaluated. Factorial validity was analyzed by confirmatory factor analyses in a representative sample of German females (n=1080). Treatment sensitivity was evaluated in a sample of 43 women with bulimia nervosa who completed the BSQ before and after cognitive-behavioral therapy. While fit indices of the full-length version of the BSQ were poor, three of the derivations had reasonable fit. If treatment sensitivity is considered, one of the short forms performed best. This derivation is one of the eight-item versions of the BSQ (suggested abbreviation: BSQ-8C). In conclusion, the present study presents the empirical background for choosing between eight different versions of the BSQ. Thus, it is no longer necessary for researchers and clinicians to make their choice based on subjective criteria. Nevertheless, research on the derivations of the BSQ as stand-alone questionnaires is needed.

Individual prognosis for changes in sperm quality on the basis of perceived stress.

Background: In this study we examined whether stress has a negative influence on sperm quality. To investigate this issue we developed a scale assessing perceived stress resulting from infertility. Methods and Results: The Infertility Distress Scale was constructed based on the data of 158 infertility patients contacting an andrological clinic for the first time. The Infertility Distress Scale consists of items assessing self-reported stress, different appraisals of infertility and cognitive involvement in infertility. The scale was shown to have good psychometric properties. Changes in sperm quality were predicted by this scale for 69 patients. Changes in sperm concentration and sperm motility were predicted correctly 75.4 and 65.6% of the time, respectively. While these prediction accuracies were significantly better than chance prediction, the Infertility Distress Scale had no predictive value for changes in morphology. Conclusion: Results indicate that distress caused by infertility is a risk factor for a decrease in sperm quality.

Why do infertile males use psychological couple counselling

The purpose of the present study was to identify characteristics of male patients that could be relevant for the uptake of psychological couple counselling for infertility. Therefore, 94 male patients who participated in psychological couple counselling were compared to 134 unselected infertility patients who attended an andrological clinic. Counselling users showed higher scores for depression and anxiety as well as a higher number of impaired sperm parameters. Multivariate analysis revealed that beyond the level of depression the number of impaired sperm parameters delivered additional information about the probability of a patient using counselling. For interpretation of these results the former research was broadly reviewed. It is suggested that an increased level of distress, the feeling of being responsible for infertility and few marital difficulties are relevant for the usage of couple counselling by male infertility patients. Practical consequences are discussed.

A validation study on the negative association between an active coping style and sperm concentration

In the present study hypotheses derived from a psychobiological model of male fertility were tested. The basic assumption of the model proposes that, mediated by specified endocrine mechanisms, an active coping style and sperm concentration are negatively correlated. Data from 55 infertile patients without organic causes for impaired spermatogenesis were included to test this assumption. Patients completed questionnaires to assess coping efforts in relation to infertility and distress due to infertility. For each patient a mean value for sperm concentration based on several semen analyses was computed. As hypothesized, there was a significant negative correlation between sperm concentration and an active coping style, but no significant correlation between sperm concentration and a passive coping style. These associations were significantly different. Previous research suggests that the confirmed association cannot be supposed to be simply a reaction to former semen analyses. The results indicate that further validation of the psychobiological model under study could lead to a better understanding of male infertility.

Figurunzufriedenheit von Frauen in Abhängigkeit vom Lebensalter: Normative Daten für den Fragebogen zum Figurbewusstsein

Hintergrund: Der Fragebogen zum Figurbewusstsein (FFB) ist weit verbreitet für die Erfassung von Figurunzufriedenheit. Bisher liegen keine angemessenen Referenzwerte vor. Die vorliegende Untersuchung schlieβt diese Lücke und legt dabei ein besonderes Augenmerk auf den Zusammenhang zwischen Lebensalter und Figurunzufriedenheit. Material und Methoden: Der FFB wurde in einer repräsentativen Stichprobe von 1060 Frauen im Alter von 14–93 Jahren eingesetzt. Ergebnisse: Es zeigten sich nur kleine Unterschiede in der Figurunzufriedenheit zwischen Altersgruppen von 14–65 Jahren, während Frauen >65 eine signifikant geringere Unzufriedenheit angaben. Bei einer niedrigen Korrelation zwischen Figurunzufriedenheit und Depressivität zeigte sich ein differenzieller Alterseffekt bei diesen beiden Merkmalen, denn Frauen >65 hatten höhere Depressionswerte. Von den Frauen zwischen 14 und 65 Jahren berichten 11,3%, dass sie in den letzten Wochen erbrochen haben, um sich dünner zu fühlen; von diesen haben sogar 2,4% zu dem gleichen Zweck des Öfteren erbrochen. In derselben Altersgruppe führen 15,2% an, dass sie in den letzten 4 Wochen Laxantien eingenommen haben, um sich dünner zu fühlen; von diesen berichten sogar 2,9% von häufigerer Laxantieneinnahme zu dem gleichen Zweck. Auf der Basis der Summenwerte von 805 Teilnehmerinnen werden Normwerte für Frauen im Alter von 14–65 Jahren angegeben. Diskussion: Der FFB scheint für altersabhängige Unterschiede in der Figurunzufriedenheit sensitiver zu sein als andere Skalen.

Kognitionen bei Infertilität: Entwicklung und Validierung eines Fragebogens (KINT)

Zusammenfassung. Infertilitat stellt fur Betroffene oftmals eine so starke Belastung dar, das sie psychotherapeutische Unterstutzung suchen. Um potentiell therapierelevante Kognitionen im Zusammenhang mit der Infertilitat erfassen zu konnen, wurde ein Fragebogen entwickelt. In einer Hauptkomponentenanalyse mit anschliesender Varimaxrotation konnten vier Faktoren extrahiert werden, die zufriedenstellende interne Konsistenzen aufwiesen. Diese Ergebnisse liesen sich fur eine zweite Stichprobe in einer konfirmatorischen Faktorenanalyse bzw. einer weiteren Reliabilitatbestimmung bestatigen. Die Faktoren waren als “Entlastende Bewertungen”, “Emotionszentrierte Gedanken”, “Problemfixierte Gedanken” sowie “Gedanken der Hilflosigkeit” zu interpretieren. In der Validierung zeigte sich, das alle Skalen mit Depressivitat korrelierten; nur fur die “Entlastenden Bewertungen” ergab sich ein negativer Zusammenhang. Zur weiteren Validierung wurden Zusammenhange mit spezifischen Copingstrategien und verfugbaren Ressourcen ...

Kann eine störungsorientierte Psychotherapie komorbide Symptome der Bulimia Nervosa verändern

Hintergrund: In zahlreichen kontrollierten Therapiestudien hat sich gezeigt, dass eine kognitiv-behaviorale, störungsorientierte Therapie der Bulimia Nervosa (BN) eine erfolgversprechende Behandlungsform zur Reduktion der bulimischen Symptomatik darstellt. Ob die Erfolge allerdings auch in der klinischen Praxis erzielt werden können, ist weniger gut belegt. Ebenso stellt sich die Frage, ob durch eine auf die spezifische Symptomatik der Essstörung abzielende Behandlung auch komorbide Symptome verändert werden können. Ziel der vorliegenden Arbeit war es, den Einfluss einer störungsorientierten Therapie von Patientinnen mit der Diagnose einer BN auf komorbide Symptome im Rahmen einer klinischen Studie in einer Versorgungseinrichtung zu untersuchen. Patienten und Methode: 66 Patientinnen («completer») mit der Diagnose einer BN (DSM-III-R) bearbeiteten eine Fragebogenbatterie (z.B. zur Erfassung von Depression, Angst, Zwanghaftigkeit, Alkoholkonsum) als Eingangsdiagnostik, 6 Wochen nach Therapieende (Post-treatment) und 1 Jahr nach Therapieende (Follow-up). Bei Therapieende lag die Stichprobengröβe bei N = 45, beim 1-Jahres-Follow-up bei N = 32. Ergebnisse: In der multivariaten und univariaten Auswertung der Ausgangswerte im Vergleich zu den Post- und Follow-up-Werten zeigten sich hochsignifikante Verbesserungen in fast allen Maβen zur komorbiden Symptomatik bei BN. Diskussion: Die vorliegende Studie liefert Hinweise darauf, dass eine symptomorientierte kognitiv-behaviorale Behandlung nicht nur zu einer Verbesserung der Essstörung im engeren Sinne führt, sondern dass dadurch auch komorbide Symptome wie Ängstlichkeit, Depressivität, allgemeines Belastungserleben sowie Zwanghaftigkeit reduziert werden können. Da es sich um eine klinische Studie innerhalb einer Versorgungseinrichtung handelt, liefern die Befunde ferner Hinweise auf die Effizienz einer kognitiv-behavioralen, manualgestützten Therapie für Patientinnen mit BN in der klinischen Praxis.

Swimming against the Tide

Accessible online at: http://BioMedNet.com/karger The independent and uncoventional attitude of this journal is now well known to our readers. The publication of the 1997 impact factors of journals listed in the Science Citation Index by the Institute for Scientific Information seems to support our quest. Our impact factor of 1.80 places Psychotherapy and Psychosomatics in the top 10 psychological journals and at the 24th position in the psychiatry ranking. The progress of the journal is depicted by figure 1, which also shows how psychosomatic medicine is alive and well at the turn of the century by including the other 4 leading psychosomatic journals. Such psychosomatic prominence is also supported by other psychosomatic journals which are included in the Science Citation Index (International Journal of Psychiatry in Medicine, Stress Medicine, Journal of Psychosomatic Obstetrics and Gynecology, Zeitschrift für Psychosomatische Medizin und Psychoanalyse). The journal’s progress has been the result of the joint effort of several factors. One factor has certainly been the expert advice of our reviewers (such as the ones listed below who supplemented the Editorial Board during 1998). In 1998 we introduced a new policy in our review process. All reviewers are asked to disclose